Outline

Objective

Even in the most experienced hands, aneurysm surgery carries a 10 % risk of intraoperative complications and incomplete aneurysm clipping. We hypothesized that neuronavigational 3-dimensional display of vessel and aneurysm anatomy, which is adjusted to the actual surgeons view, could be helpful during the critical steps of aneurysm treatment.

Methods

A total number of 35 patients with 45 aneurysms entered this prospective clinical trial. With a neuronavigational system, a 3-dimensional image of the arterial vascular anatomy was generated either by manual (7 patients) or by semi-automatic segmentation (28 patients) of a computerized tomography (CT) angiographic data set. The 3-dimensional image was then adjusted to the surgeon`s perspective by rotation. With a neuronavigational pointer, the surgeon linked the image information with the vascular structures in his surgical field. If required, the image with the displayed pointer was rotated further for visualization of hidden structures. After the operation, the surgeon evaluated the role of neuronavigation.

Results

Neuronavigation was deemed useful in 40 out of the 45 approached aneurysms (89 %). Neuronavigation helped to localize the aneurysm (n=25), understand the branching anatomy (n=10), evaluate the projection of the aneurysm dome (n=6), and to tailor the approach (n=2). The role of neuronavigation was influenced by the site and size of the attacked aneurysm. A favorable outcome was achieved in 32 of the 35 patients (91 %).

Conclusions

In our experience, neuronavigational 3-dimensional display of the vessel anatomy facilitated critical steps of microsurgical aneurysm clipping. We assume, that this technique has the potential to improve operative results by reduction of the surgical trauma and avoidance of intraoperative complications. The high rate of favorable results supports that assumption.